INTRODUCTION:
In a secondary level public health assistance, in Brazil (1), a patient lost her life. She had no adherence to treat Acquired Immuno-deficient Syndrome (AIDS) for fifteen years. Since March 2010, when she was nineteen years old, pregnant, and diagnosed, the treatment was irregular. Another time pregnant in 2012, deprived of liberty (2012-2014), and with a concomitant extra-lungs treatment against tuberculosis. Illicit drugs and alcohol used. She became sick with a cholestatic not diagnosed disease in 2017. The aim of this case relate is discussing, and answering with experts the bad evolution case with extremely altered laboratorial results and melanic jaundice.

METHODS:
Review of a post-mortem clinical records, from different health care services, from different cities, where she migrated for unknown reasons.

RESULTS:
Alkaline phosphatase twenty times elevated. Bilirubin sixty times elevated. Low albumin at protein electrophoresis. High serum low-density lipoprotein (LDL) cholesterol. Normocytic anemia. Elevated reactive C protein. Serum and image markers rule neoplasms. Serum autoimmune tests negatives. Endoscopic retrograde cholangiopancreatography with flat duodenal papilla. Computed tomography without focal lesions, nor esteatosis, nor cirrhosis. No data on intrinsic or extrinsic biliary obstruction (magnetic resonance cholangiopancreatography – September 2024). Chronic liver failure suggested macrophage activation syndrome with opportunistic infection, but not diagnosed. No invasive diagnostic method applied (2).

CONCLUSIONS:
She did not adhere to actual treatment. Maintaining a low CD4 T lymphocytes count (the last was 46 cells by cubic milliliter, the worst was 18) (3), she became worse and worse with cachexia, scratching, and melanic jaundice. Hospitalized because she was unable to feed herself, died in July 2025.